영아 연축 환아의 99mTc-HMPAO SPECT 검사에 의한 국소 뇌혈류 동태

안여현(Yeo Hyeon Ahn),김영희(Young Hee Kim),최승희(Seung Hee Choi),김병주(Byung Ju Kim),박기원(Ki Won Park),우영종(Youn Jong Woo) 대한소아신경학회 1996 대한소아신경학회지 Vol.3 No.2

연구배경 : 영아 연축은 전신성 발작으로 간주 되고 있으나 최근에는 부분 발작과의 관계 및 PET(positron emission tomography), SPECT(single photon emission computed tomography)등의 기능적 영상 진단 검사에 의한 뇌의 국소 이상 소견에 대한 관심이 높아지고 있으며 국소 뇌 절제수술에 의한 영아 연축의 치료가 시도되고 있다. 99mTc-HMPAO SPECT법에 의한 국소 뇌 혈류 검사는 비교적 간단히 시행할 수 있어 소아과 임상에서 널리 이용되고 있으며 특히 소아기의 발작 간헐기 SPECT 검사 소견은 기질적 간질 병소의 진단에 많이 이용되고 있다. West 증후군에서 SPECT 검사에 대한 보고는 드물고 ACTH 치료후 예후와 비교 고찰한 성적은 별로 없기 때문에 이를 알아보고자 본 연구를 시행하였다. 방법: 1987년 이후 전남대학교병원 소아과에서 영아 연축으로 진단되어 ACTH(40 U)를 투여하였던 28례의 환자들중 EEG, CT/MRI, 99mTc-HMPAO SPECT 검사를 시행하였던 10례(남 7, 여 3)의 결과를 검토하였다. 추적 관찰 기간동안 발작의 유무, 발작 양상, 행동 및 지능 발달 정도를 조사하였고 이 결과를 CT/MRI SPECT 검사의 소견과 비교하였다. 결과: 1. 영아 연축의 시작 시기는 3개월에서 10개월 사이로 평균 5.4개월이었다. 출생 후 발달이 정상적이었으며 신경학적 이상 소견이 없이 영아 연축이 시작되었던 경우가 7례였으며, CT/MRI 검사에 뇌 위축 소견을 보였던 경우는 4례, 결절성 경화증으로 진단된 경우 2례로서, 증후성으로 생각되었던 경우는 6례(60%)였다. ACTH 및 항경련제의 투여후 추적 관찰 기간 동안 4례는 발작이 완전히 소실되었으나, 2례는 Lennox-Gastaut증후군으로 이행하였고 4례는 복잡 부분 발작과 근간대성 발작이 나타났다. 추적 기간동안의 발달 지연은 7례에서 나타났다. 2. SPECT 검사상 이상 소견을 보인 경우는 5례(50%)이고 주로 전두엽 및 측두엽에서 혈류감소를 보였다. CT/MRI에 이상이 발견되지 않는 경우에도 2례에서 SPECT 검사에 국소 혈류 감소를 보였으며, 2례의 결절성 경화증의 경우 1례는 정상, 1례는 좌측 후측두엽의 국소혈류 감소를 보였다. CT/MRI에 경도의 미만성 뇌 위축을 보였던 경우 2례에서는 SEPCT 검사에는 정상 소견을 정하였다. 3. CT/MRI, SPECT 검사에 모두 정상 소견을 보인 2례는 경련 발작이 없어졌으며 뇌파 소견도 정상이 되고, 추적 기간 동안 발달도 정상이었다. CT/MRI에는 이상이 발견되지 않았으나 SPECT 검사에 이상을 보인 2례는 모두 발달지연 및 경련발작을 보였다. CT/MRI에는 이상이 발견되었으나 SPECT 검사에 정상이었던 3례는 2례에서 발달지연을 보였고, 발작 예후는 1례에서 Lennox-Gastaut 증후군, 2례는 발작이 소실되었다. CT/MRI, SPECT 모두에서 이상 소견을 보였던 3례는 모두 발달지연을 보였으며 발작이 지속되었다. 결론 : 잠인성 영아 연축의 진단 기준을 정할때에 SPECT 검사를 포함시키는 것이 장기 예후를 추정하는데 더 유용하리라고 생각되었으며, 증후성인 경우에도 기질적 병변과는 약간 다른 SPECT 소견을 정할 수 있으므로 증후성 영아연축의 예후 추정에도 SPECT 검사는 유용할 것으로 추정되었다. To evaluate the clinical usefulness of 99mTc-HMPAO single photon emission computed tomography(SPECT) study in predicting the outcomes of West syndrome, clinical profiles including CT/MRI, EEG, SPECT finding at the onset of spasms and developmental outcome and seizure control after ACTH and other antiepileptic treatment were investigated in 10 infantile spasm patients(male 7. female 3). CT/MRI revealed brain abnormalities in 6 cases(4 diffuse cortical atrophy, 2 tuberous sclerosis). SPECT showed hypoperfusion in the frontal or temporal areas in 5 cases. Two cases with normal CT/MRI, and SPECT findings had normal development and no seizure after ACTH treatment. Two with normal CT/ MRI and abnormal SPECT showed developmental delay and seizures on follow-up. Two of three cases with abnormal CT/MRI and normal SPECT showed developmental delay and 2 of them had no seizure and one became Lennox-Gastaut syndrome. All 3 cases with abnormal CT/MRI, SPECT showed developmental retardation and intractable epilepsy. Our study indicates that the normal SPECT finding should be included in the criteria for the definition of cryptogenic infantile spasm and might have some role in predicting outcomes even in the symptomatic group.

외상성 뇌손상 환자에서 SPECT와 MRI 소견의 비교 연구

김영철 大韓神經精神醫學會 1999 신경정신의학 Vol.38 No.2

연구목적과 방법 : 본 연구에서는 외상성 뇌손상후 객관적 이상의 유무를 찾아내는데 MRI와 SPECT중 어느 것이 더 효과적인지 알아보고자 하였다. 1997년 1월부터 1998년 6월까지 18개월동안 이대 목동병원 신경정신과에서 신체감정서가 발부되었던 외상성 뇌손상 환자중 MRI. SPECT, EEG를 모두 시행한 51명을 대상으로 검사결과를 검토하여 두뇌의 이상여부를 어느 검사가 효과적으로 찾아내는지 비교 조사하였으며 그 결과는 다음과 같다. 결 과 : 연구대상 환자중 MRI에서 비정상 소견을 보인 경우는 11명(21.6%)이였으나 SPECT에 이상소견을 보인 경우는 27명(52.9%)이나 되어 SPECT 검사로 뇌손상후의 이상소견을 찾을 수 있는 가능성이 유의하게 높았다.(p〈0.05). 그러나 MRI에서 비정상적인 경우(3명)에서 SPECT가 기능이상을 찾아내지 못했기 때문에 MRI나 SPECT를 단독으로 검사하기보다는 함께 검사하는 것이 외상성 뇌손상 환자에서의 이상여부를 찾아내는데 효과적이라 할 수 있다. 반면 뇌파검사는 뇌의 기능이상을 찾는데 효과적인 검사가 아니었다. 민사소송까지의 기간 및 두 검사 결과에 대한 교육수준이나 성별차이는 유의하지 않았다. 결 론 : 외상성 뇌손상 환자들에서 뇌의 이상유무를 찾아내는 데는 MRI보다 SPECT가 더 효과적 검사법이라 할 수 있지만 두 검사를 동시에 시행하는 것이 추천할만한 방법이라 하겠다. In this study, the author tried to compare the efficiency of SPECT with that of MRI in evaluation of neuropsychiatric sequelae after traumatic brain injury(TBI). Fifty-one patients who were referred from the court for the purpose of assessment of neurobehavioral disability after TBI for 18 mouths from Jan, 1997 to Jun. 1998 were reviewed. The results were as follows : 1) SPECT was more effective to find out brain abnormality than MRI because 27 of 51 patients(52.9%) showed abnormal findings on SPECT but 11(21.6%) on MRI(p〈0.05). 2) There were no abnormal finding on SPECT even three of the patients showed abnormality on MRI. 3) The use of electroencephalogram(EEG) was not a helpful method to evaluate abnormal brain function in patients with chronic sequelae after TBI. 4) The relationship between education level and laboratory findings of MRI and SPECT was not found. These results suggest the SPECT alone or combination with MRI would be helpful to find out abnormal brain function efficiently in patients with sequale after TBI.

SPECT/CT에서 감쇠 보정 및 위치 정보의 유용성 평가

최종숙,정우영,신상기,조시만,Choi, Jong-Sook,Jung, Woo-Young,Shin, Sang-Ki,Cho, Shee-Man 대한핵의학기술학회 2008 핵의학 기술 Vol.12 No.2

목적 : 융합 SPECT/CT가 기존 SPECT에 비해 병소의 해부학적 위치를 정확히 판단할 수 있는지 정성 평가하고, CT 감쇠 보정이 SPECT 영상에 미치는 효과를 알아보아 SPECT/CT의 유용성을 제시하고자 한다. 실험재료 및 방법 : 1. 융합 영상의 평가 : 2008년 1월(月)부터 8월(月)까지 Precedence 16 혹은 Symbia T2에서 $^{131}I$-MIBG, Bone, $^{111}In$-Octreotide, Meckel 게실, Parathyroid MIBI 등을 SPECT/CT 시행한 환자를 대상으로 하였고, SPECT/CT영상을 융합한 것과 하지 않은 것을 비교하여 정성 평가하였다. 2. 감쇠보정의 평가 : Symbia T2로 2008년 6월에서 8월까지 $^{201}Tl$ 심근 검사를 한 환자 38명을 대상으로 Cedars-Sinai의 QPS를 이용하여 산출하였다. Ant, Inf, Lat, Septum, Apex로 5개부분으로 분류하고, 각 부분에 대한 관류의 상태를 백분율로 산출했다. CT AC와 Non AC를 평균${\pm}$표준편차로 각 부분에 대한 관류 상태를 비교하고 차이를 분석하였다. 결과 : 1. 융합 영상의 평가 : 에너지가 높은 $^{131}I$ SPECT의 경우 병소와 주위 조직 간의 섭취율 차이로 인해 (주위 조직이 saturation 됨) 병소의 위치 파악이 어려웠으나 CT로 융합한 결과 해부학적 위치를 정확히 평가할 수 있었다. 또한 멕켈게실이나 $^{111}In$과 같이 장이나 장기쪽에 질환을 찾는 경우에는 그 우수성이 더욱 뛰어 났다. Bone SPECT/CT는 척추간의 구별을 확실히 할 수 있어 임상의가 정확한 결과를 제시하는데 도움을 준다. 2. 감쇠 보정의 평가 : 감쇠 보정 전후의 관류 백분율의 차이가 Ant, Lat에서는 통계적으로 유의한 차이가 없었으나(p>0.05), Inferior, Apex, Septum에서는 유의한 차이가 있었다(p<0.05). 차이를 보이는 값 중 Inferior Wall에서 CT AC perfusion : $76.84{\pm}6.52%$, Non AC perfusion : $68.58{\pm}7.55%$로 CT 보정에 의한 차이가 $8.26{\pm}4.95%$로 가장 크게 측정되었다(t=10.29, p<0.01). 결론 : SPECT에 CT가 부착되면서 병변의 기능적 활성도를 나타내는 분자학적 영상은 물론 병변의 해부학적 위치 정보를 보다 정확하게 확인할 수 있게 되었다. 이것은 비정상적 부위를 찾아내는 것에 그치지 않고 복잡한 인체 부위에서 정상군과 비정상군을 분리하는데 많은 도움을 주게 되었다. 따라서 임상의는 하나의 검사 영상으로 진단과 치료계획을 동시에 시행할 수 있을 것이다. 또한 감쇠가 잘 되는 흉곽 부위 안에 있는 심근 검사에는, CT로 보다 정확한 감쇠 보정을 할 수 있기 때문에 SPECT 검사 시 관심부위의 관류 상태를 더욱 신뢰할 수 있어 치료 예후의 정당성을 입증할 수 있을 것으로 판단된다. Purpose: We make a qualitative analysis of whether Fusion SPECT/CT can find lesion's anatomical sites better than existing SPECT or not, and we want to show the usefulness of SPECT/CT through finding out effects of CT attenuation correction on SPECT images. Materials and Method: 1. The evaluation of fusion images: This study comprised patients who was tested $^{131}I$-MIBG, Bone, $^{111}In$-Octreotide, Meckel's diverticulum, Parathyroid MIBI with Precedence 16 or Symbia T2 from 2008 Jan to Aug. We compared SPECT/CT image with non fusion image and make a qualitative analysis. 2. The evaluation of attenuation correction: We classified 38 patients who was tested 201Tl myocardial exam with Symbia T2 into 5 sections by using Cedars Sinai' QPS program - Ant, Inf, Lat, Septum, Apex. And we showed each section's perfusion states by percentage. We compared the each section's perfusion-states differences between CT AC and Non AC by average${\pm}$standard deviation. Results: 1. The evaluation of fusion images : In high energy $^{131}I$ cases, it was hard to grasp exact anatomical lesions due to difference between regions and surrounding lesions' uptake level. After combining with CT, we could grabs anatomical lesion more exactly. And in meckel's diverticulum case or to find lesions around bowels or organs with $^{111}In$ cases, it demonstrates its superiority. Bone SPECT/CT images help to distinguish between disk spaces certainly and give correct results. 2. The evaluation of attenuation correction: There is no significant difference statistically in Ant and Lat (p>0.05), but there is a meaningful difference in Inferior, Apex and Septum (p<0.05). AC perfusion at inferior wall in the 5 sections of myocardium: The perfusion difference between Non AC perfusion image ($68.58{\pm}7.55$) and CT corrected perfusion image ($76.84{\pm}6.52$) was the largest by $8.26{\pm}4.95$ (p<0.01, t=10.29). Conclusion: Nuclear medicine physicians can identify not only molecular image which shows functional activity of lesions but also anatomical location information of lesions with more accuracy using the combination of SPECT and CT systems. Of course this combination helps nuclear medicine physician find out the abnormal parts. Moreover combined data sets help separate between normal group and abnormal group in complicated body part. So clinicians can carry out diagnosis and treatment planning at the same time with a single test image. In addition, when we examine a myocardium in thorax where attenuation can occur easily, we can trust perfusion more in a certain region in SPECT test because CT provides the capability for accurate attenuation correction. In these reasons, we think we can prove the justice after treatment fusion image.

Usefulness of CT based SPECT Fusion Image in the lung Disease

박훈희(Hoon-Hee Park),김태형(Tae-Hyung Kim),신지윤(Ji Yun Shin),이태수(Tae Soo Lee),유광열(Kwang Yeul Lyu) 대한방사선과학회(구 대한방사선기술학회) 2012 방사선기술과학 Vol.35 No.1

최근에는 SPECT/CT의 보급으로 융합영상을 여러 질환에 적용하고 있지만, 폐질환에 대한 적용은 널리 이용 되고 있지 않다. 특히, CT 결과에서 폐색전증을 의심하여 SPECT를 시행하는 경우가 발생하며, 보다 정확한 진단을 위해 SPECT/CT가 중요하다. 하지만, SPECT/CT를 보유하지 않은 병원에서는 적용에 한계가 발생하며, SPECT/CT를 보유한 병원에서 검사를 시행한다 하더라도 이미 CT검사 이후 SPECT/CT를 진행하는 경우가 많다. CT검사에서 발생하는 피폭선량 외에도 추가적인 SPECT/CT는 이중으로 피폭선량을 발생하는 경우 해당되며, 불필요한 피폭이 발생하는 경우에 속한다. 그러므로 본 연구에서는 불필요한 피폭을 방지하고, SPECT/CT를 보유하지 않은 의료기관에서 SPECT와 CT의 각각 획득된 영상을 융합하고, 폐질환에서의 영상의 유용성을 평가하였다. 팬텀실험은 NEMA Phantom™(NU2-2001)으로 SPECT와 CT에서 획득된 영상을 융합하였으며, 임상적용은 10명의 환자(남자 7명, 여자3명, 평균나이: 65.3세±12.7세)를 대상으로 각각의 영상을 융합하여 분석하였다. 팬텀실험과 임상적용에서 모두 SPECT, CT의 각각의 영상보다 fusion image에서 높은 점수를 나타내었으며, SPECT와 CT영상을 fusion하여 각각의 장점을 극대화 할 수 있었다. CT영상으로부터 획득한 폐혈관 image가 SPECT로부터 얻은 기능적인 영상을 fusion함으로써 pulmonary embolism이 폐실질에 나타내는 영향을 더욱 잘 묘사할 수 있었다. SPECT/CT가 가장 이상적이라 할 수 있지만, 아직 보급되어 있지 않은 경우 이와 같은 프로토콜을 이용하여 진단에 사용한다면 보다 정확한 진단에 도움이 되리라 사료된다. Recently, SPECT/CT system has been applied to many diseases, however, the application is not extensively applied at pulmonary disease.Especially, in case that, the pulmonary embolisms suspect at the CT images, SPECT is performed. For the accurate diagnosis, SPECT/CT tests are subsequently undergoing.However, without SPECT/CT, there are some limitations to apply these procedures. With SPECT/CT, although, most of the examination performed after CT. Moreover, such a test procedures generate unnecessary dual irradiation problem to the patient. In this study, we evaluated the amount of unnecessary irradiation, and the usefulness of fusion images of pulmonary disease, which independently acquired from SPECT and CT. Using NEMA Phantom™ (NU2-2001), SPECT and CT scan were performed for fusion images. From June 2011 to September 2010, 10 patients who didn't have other personal history, except lung disease were selected (male: 7, female: 3, mean age: 65.3±12.7). In both clinical patient and phantom data, the fusion images scored higher than SPECT and CT images. The fusion images, which is combined with pulmonary vessel images from CT and functional images from SPECT, can increase the detection possibility in detecting pulmonary embolism in the resin of lung parenchyma. It is sure that performing SPECT and CT in integral SPECT/CT system were better. However, we believe this protocol can give more informative data to have more accurate diagnosis in the hospital without integral SPECT/CT system.

Repeated ictal SPECT in partial epilepsy patients: SISCOM analysis

Lee, Jun Young,Joo, Eun Yeon,Park, Hwan Seok,Song, Pamela,Young Byun, So,Seo, Dae Won,Hong, Seung Bong Blackwell Publishing Ltd 2011 Epilepsia Vol.52 No.12

<P><B>Summary</B></P><P><B>Purpose: </B> Ictal single‐photon emission computerized tomography (SPECT) is often nonlocalized in patients with partial epilepsy. We repeated ictal SPECT in patients with partial epilepsy whose first ictal SPECT was nonlocalized. We also performed subtraction ictal SPECT coregistered to magnetic resonance imaging (MRI) (SISCOM) to test the localizability of ictal SPECT.</P><P><B>Methods: </B> We recruited 69 patients with partial epilepsy (33 male and 36 female, mean plus or minus standard deviation age 29.5 ± 12.2 years), who had a repeated ictal SPECT. Ictal‐interictal SPECT subtractions were performed, and the subtracted SPECTs were coregistered with their brain MRI studies. SISCOM results were considered to be localizing when the results were concordant with the final location of the epileptic focus, as determined by the presurgical evaluation. We compared seizure duration, tracer injection time, interictal and ictal scalp electroencephalography (EEG) patterns, presence and time of secondary generalization, and epilepsy classification between the localized and nonlocalized SISCOM groups.</P><P><B>Key Findings: </B> The SISCOM results of the second ictal SPECT were localized in 43 (62.3%) patients and nonlocalized in 26 (37.7%) patients. In the second ictal SPECT, the radiotracer injection time was significantly shorter in the localized group (25.1 ± 8.9 s), as compared to the nonlocalized group (49.2 ± 55.8 s) (p = 0.008). Furthermore, the radiotracer injection time of the second ictal SPECT was significantly shorter than the first ictal SPECT, only in the localized group (36.8 ± 23.8 s in the first and 25.1 ± 8.9 s in the second ictal SPECT in the localized group, p = 0.004). The percent injection time ([(tracer injection time−seizure onset time)/total seizure duration] × 100%) in the second SPECT was significantly shorter in the localized group, as compared to the nonlocalized group (37.9 ± 23.0% in the localized group and 72.3 ± 46.2% in the nonlocalized group, p < 0.001). The localized ictal EEG patterns at the time of injection were more frequent in the localized SISCOM group. The secondary generalization of seizures at the time of injection was more frequent in nonlocalized groups.</P><P><B>Significance: </B> Repeated ictal SPECT with SISCOM analysis is helpful for localizing an epileptic focus in patients with partial epilepsy who have a nonlocalized first ictal SPECT. The most important factor for increasing the localizability of repeated ictal SPECT is early injection time and a localizing ictal EEG pattern at the time of radiotracer injection.</P>

Lung Ventilation SPECT에서 LEAP Collimator의 유용성에 관한 연구

김정수,김수미,김진의,이재성,이동수,Kim, Jung Soo,Kim, Soo Mee,Kim, Jin Eui,Lee, Jae Sung,Lee, Dong Soo 대한핵의학기술학회 2012 핵의학 기술 Vol.16 No.2

Purpose : Although lung ventilation SPECT (LV-SPECT) has a good sensitivity in detection of deep lung lesions, it is difficult to apply the LV-SPECT to patients having breathing problems due to limited examination time. In this study, we evaluated the usefulness of LEAP collimator, which provides high detection sensitivity and tolerable resolution, for the LV-SPECT in terms of diagnostic accuracy and examination time. Materials and Methods : Four volunteers inhaled Technegas (370 MBq) and the lung ventilation planar scan (LVPS, 300 counts/view (cpv)) with LEHR collimator was performed using Siemens E.cam scanner as a reference test. LV-SPECT scans were performed with three collimators, LEHR, LEUHR, and LEAP, in low (7 kcpv) and high (70 kcpv) counting modes. The count ratios of left (LT) and right (RT) lung segments were calculated on the geometric mean view of anterior and posterior images for LVPS and on the summed coronal images of LV-SPECT, respectively. Comparing to LVPS, the usefulness of three different collimators for LV-SPECT was evaluated through statistical analysis (paired t-test), on count ratios of lung segments. Results : The average LT:RT ratio in LVPS was 47:53. For LV-SPECT, there were negligible difference of the LT:RT ratios (48:52 on average) among three different collimators in low and high counting modes. Comparing to standard LVPS with LEHR, all LV-SPECTs with different collimators resulted in similar diagnostic accuracy through paired t-test (p>0.05). The scan time in LVPS (6 views) was 17.3 min. For LV-SPECT (128 views) in low counting mode, it took 18.7 (LEUHR), 15.0 (LEHR), and 12.3 min (LEAP), respectively. Conclusion : Comparing to standard LVPS, the LV-SPECT with LEAP in low counting mode provided the comparable diagnostic accuracy in addition to shortened scan time.

$^{99m}Tc$을 이용한 심근 관류 SPECT에서 Multiple Confocal SPECT System의 유용성

신채호,표성재,김봉수,조용귀,조진우,김창호,Shin, Chae-Ho,Pyo, Sung-Jai,Kim, Bong-Su,Cho, Yong-Gyi,Jo, Jin-Woo,Kim, Chang-Ho 대한핵의학기술학회 2011 핵의학 기술 Vol.15 No.2

Purpose: The recently adopted multiple confocal SPECT SYSTEM (hereinafter called IQ SPECT$^{TM}$) has a high difference from the conventional myocardial perfusion SPECT in the collimator form, image capture method, and image reconstruction method. This study was conducted to compare this novice equipment with the conventional one to design a protocol meeting the IQ SPECT, and also determine the characteristics and usefulness of IQ SPECT. Materials and Methods: 1. For the objects of LEHR (Low energy high resolution) collimator and Multiple confocal collimator, $^{99m}Tc$ 37MBq was put in the acrylic dish then each sensitivity ($cpm/{\mu}Ci$) was measured at the distance of 5 cm, 10 cm, 20 cm, 30 cm, and 40 cm respectively. 2. Based on the sensitivity measure results, IQ SPECT Protocol was designed according to the conventional general myocardial SPECT, then respectively 278 kBq/mL, 7.4 kBq/mL, and 48 kBq/mL of $^{99m}Tc$ were injected into the myocardial and soft tissues and liver site by using the anthropomorphic torso phantom then the myocardial perfusion SPECT was run. 3. For the comparison of FWHMs (Full Width at Half Maximum) resulted from the image reconstruction of LEHR collimator, the FWHMs (mm) were measured with only algorithms changed, in the case of the FBP (Filtered Back projection) method- a reconstruction method of conventional myocardial perfusion SPECT, and the 3D OSEM (Ordered subsets expectation maximization) method of IQ SPECT, by using $^{99m}Tc$ Line source. Results: 1. The values of IQ SPECT collimator sensitivity ($cpm/{\mu}Ci$) were 302, 382, 655, 816, 1178, and those of LEHR collimator were measured as 204, 204, 202, 201, 198, both at the distance of 5 cm, 10 cm, 20 cm, 30 cm, and 40 cm respectively. It was found the difference of sensitivity increases up to 4 times at the distance of 30 cm in the cases of IQ SPECT and LEHR. 2. The myocardial perfusion SPECT Protocol was designed according to the geometric characteristics of IQ SPECT based on the sensitivity results, then the phantom test for the aforesaid protocol was conducted. As a result, it was found the examination time can be reduced 1/4 compared to the past. 3. In the comparison of FWHMs according to the reconstructed algorithm in the FBP method and 3D OSEM method followed after the SEPCT test using a LEHR collimator, the result was obtained that FWHM rose around twice in the 3D OSEM method. Conclusion : The IQ SPECT uses the Multiple confocal collimator for the myocardial perfusion SPECT to enhance the sensitivity and also reduces examination time and contributes to improvement of visual screen quality through the myocardial-specific geometric image capture method and image reconstruction method. Due to such benefits, it is expected patients will receive more comfortable and more accurate examinations and it is considered a further study is required using additional clinical materials.

심근 기능 측정에 사용된 게이트 심근 관류 SPECT 방법의 재현성 평가 : 201Tl과 99mTc-MIBI 게이트 SPECT의 비교

현인영(In Young Hyun),서정기(Jung Gee Seo),홍의수(Eui Soo Hong),김대혁(Dae Hyuck Kim),김성은(Sung Eun Kim),권준(Jun Gwon),박금수(Geum Soo Park),최원식(Won Sik Choi),이우형(Woo Hyung Lee) 대한핵의학회 2000 핵의학 분자영상 Vol.34 No.5

Purpose: We compared the reproducibility of 201Tl and 99mTc-sestamibi (MIBI) gated SPECT measurement of myocardial function using the Germano algorithm. Materials and Methods: Gated SPECT acquisition was repeated in the same position in 30 patients who received 201Tl and in 26 who received 99mTc-MIBI. The quantification of end-diastolic volume (EDV), end-systolic volume (ESV), and ejection fraction (EF) on 201Tl and 99mTc-MIBI gated SPECT was processed independently using Cedars quantitative gated SPECT software. The reproducibility of the assessment of myocardial function on 201Tl gated SPECT was compared with that of 99mTc-MIBI gated SPECT. Results: Correlation between the two measurements for volumes and EF was excellent by the repeated gated SPECT studies of 201Tl (r=0.928 to 0.986; p<0.05) and 99mTc-MIBI (r=0.979 to 0.997; p<0.05). However, Bland Altman analysis revealed the 95% limits of agreement (2 SD) for volumes and EF were tighter by repeated 99mTc-MIBI gated SPECT (EDV: 14.1 ml, ESV: 9.4 ml and EF: 5.5%) than by repeated 201Tl gated SPECT (EDV: 24.1 ml, ESV: 18.6 ml and EF: 10.3%). The root mean square (RMS) values of the coefficient of variation (CV) for volumes and EFs were smaller by repeated 99mTc-MIBI gated SPECT (EDV: 2.1 ml, ESV: 2.7 ml and EF: 2.3%) than by repeated 201Tl gated SPECT (EDV: 3.2 ml, ESV: 3.5 ml and EF: 5.2%). Conclusion: 99mTc-MIBI provides more reproducible volumes and EF than 201Tl on repeated acquisition gated SPECT. 99mTc-MIBI gated SPECT is the preferable method for the clinical monitoring of myocardial function.

게이트 TI-201 관류 SPECT와 Cedars 소프트웨어를 이용하여 측정한 좌심실 구혈률

현인영(In Young Hyun),김성은(Sung Eun Kim),서정기(Jeong Kee Seo),홍의수(Eui Soo Hong),권준(Jun Kwan),박금수(Keum Soo Park),이우형(Woo Hyung Lee) 대한핵의학회 2000 핵의학 분자영상 Vol.34 No.3

Purpose: We compared estimates of ejection fraction (EF) determined by gated Tl-201 perfusion SPECT (g-TI-SPECT) with those by gated blood pool (GBP) scan. Materials and Methods: Eighteen subjects underwent g-TI-SPECT and GBP scan. After reconstruction of g-TI-SPECT, we measured EF with Cedars software. The comparison of the EF with g-TI-SPECT and GHP scan was assessed by correlation analysis and Bland Altman plot. Results: The estimates of EF were significantly different (p<0.05) with g-TI-SPECT (40%±14%) and GBP scan (43%±14%). There was an excellent correlation of EF between e-TI-SPECT and GBP scan (r=0.94, p<0.001). The mean difference of EF between GRP scan and g-TI- SPECT was +3.2%, Ninety-five percent limits of agreement were +9,8%. EF between g-TI-SPECT and GBP scan were in poor agreement. Conclusion: The estimates of EF by g-TI-SPECT was well correlated with those by GBP scan. However, EF of g-TI-SPECT doesn't agree with EF of GBP scan. EF of g-TI-SPECT cant be used interchangeably with EF of GBP scan. (Korean J Nucl Med 2000;34:222-7)

신경세포이주장애 ; 자기공명영상(MRI), 단일광자단층활영(SPECT) 및 양전자단층촬영 (PET) 소견

김지수외9명 대한신경과학회 1997 대한신경과학회지 Vol.15 No.5